Enhancing Behavior Change Skills in Health Extension Workers in Ethiopia: Evaluation of an Intervention to Improve Maternal and Infant Nutrition

Maternal and infant nutrition are problematic in areas of Ethiopia. Health extension workers (HEWs) work in Ethiopia’s primary health care system, increasing potential health service coverage, particularly for women and children, providing an opportunity for health improvement. Their roles include improving maternal and infant nutrition, disease prevention, and health education. Supporting HEWs’ practice with ‘non-clinical’ skills in behavior change and health communication can improve effectiveness. This intervention study adapted and delivered a UK-developed training intervention for Health Extension Workers (HEWs) working with the United Nations World Food Programme in Ethiopia. The intervention included communication and behavioral training adapted with local contextual information. Mixed methods evaluation focused on participants’ reaction to training, knowledge, behavior change, and skills use. Overall, 98 HEWs were trained. The intervention was positively received by HEWs. Pre-post evaluations of communication and behavior change skills found a positive impact on HEW skills, knowledge, and motivation to use skills (all p < 0.001) to change women’s nutritional behavior, also demonstrated in role-play scenarios. The study offered substantial learning about intervention delivery. Appropriate cultural adaptation and careful consideration of assessment of psychological constructs are crucial for future delivery.     

Effects of Staff Training on Nursing Home Residents’ End-Of-Life Care: A Randomized Controlled Trial

ObjectivesThis trial examines the effects of end-of-life training on long-term care facility (LTCF) residents' health-related quality of life (HRQoL) and use and costs of hospital services.DesignA single-blind, cluster randomized (at facility level) controlled trial (RCT). Our training intervention included 4 small-group 4-hour educational sessions on the principles of palliative and end-of-life care (advance care planning, adverse effects of hospitalizations, symptom management, communication, supporting proxies, challenging situations). Training was provided to all members of staff. Education was based on constructive learning methods and included resident cases, role-plays, and small-group discussions.Setting and participantsWe recruited 324 residents with possible need for end-of-life care due to advanced illness from 20 LTCF wards in Helsinki.MethodsPrimary outcome measures were HRQoL and hospital inpatient days per person-year during a 2-year follow-up. Secondary outcomes were number of emergency department visits and cost of all hospital services.ResultsHRQoL according to the 15-Dimensional Health-Related Quality-of-Life Instrument declined in both groups, and no difference was present in the changes between the groups (P for group .75, adjusted for age, sex, do-not-resuscitate orders, need for help, and clustering). Neither the number of hospital inpatient days (1.87 vs 0.81 per person-year) nor the number of emergency department visits differed significantly between intervention and control groups (P for group .41). The total hospital costs were similar in the intervention and control groups.Conclusions and ImplicationsOur rigorous RCT on end-of-life care training intervention demonstrated no effects on residents’ HRQoL or their use of hospitals. Unsupported training interventions alone might be insufficient to produce meaningful care quality improvements.     

激励式呼吸训练联合口腔去污染对老年胃癌患者手术后肺炎的影响

目的 探讨激励式呼吸训练联合口腔去污染对老年胃癌患者手术后肺炎（POP）的影响。方法 前瞻性收集2019年1月—2020年6月在福建中医药大学附属第二人民医院行胃癌根治术老年患者,随机分成试验组和对照组。对照组行围手术期常规护理,试验组在此基础上采用激励式肺计量器训练联合洗必泰口腔去污染。分析两组POP发病率、口咽部定植菌检出率等指标。结果 共纳入96例老年胃癌手术患者,试验组和对照组各48例。13例患者发生POP,POP发病率为13.54%。试验组患者POP发病率为6.25%,低于对照组的20.83%,差异有统计学意义（P<0.05）。干预后试验组患者口咽部定植菌检出率（6.25%）低于对照组（20.83%）,差异有统计学意义（P<0.05）;干预后试验组患者6 min步行距离及呼吸训练依从性均高于对照组,差异有统计学意义（均P<0.05）;试验组术中机械通气时间、术后住院日数、抗菌药物费用、总住院费用均低于对照组,差异有统计学意义（均P<0.05）。结论 老年胃癌患者围手术期进行激励式呼吸训练和口腔去污染有助于改善运动耐量,减少呼吸道微生物定植,降低POP发病率,促进患者康复。     

失效模式与效应分析法在神经内科ICU医院感染控制中的应用

目的探讨失效模式与效应分析法(failure mode and effects analysis,FMEA)在神经内科ICU医院感染控制中的应用,发现高风险因素,为院感防控提供参考依据。方法根据神经内科ICU临床实际情况,通过FMEA风险评估法对34项医院感染风险事件进行风险评估,按照"二八法则"筛选出风险优先级事件。结果根据每一项风险因素的平均RPN值进行风险排序,按照"二八法则"筛选出风险优先级前6位的事件分别是:本科室医护人员手卫生依从性不到位(平均RPN值=5.6)、导尿管日常维护不到位(平均RPN值=4.17)、多耐患者未有效执行接触隔离措施(平均RPN值=3.80)、物表清洁消毒未有效执行(平均RPN值=3.73)、未严格掌握留置导尿指征(平均RPN值=3.70)、未保持尿液引流系统的密闭性(平均RPN值=3.53)。结论FMEA风险评估法可以发现神经内科ICU医院感染防控中的薄弱环节,为精准化感控措施的制订提供依据。     

新冠肺炎疫情定点医院的改造与思考

分析了综合医院临时改造为收治新冠肺炎患者定点医院时所遇到的问题,针对医院路线、门诊及住院楼区域、供氧设备、涉及人员及救治体系等采取符合传染病防护要求的改造措施。建议综合医院引入传染病医院建设与管理理念,合理规划建筑布局和医疗设备精细化布局,完善人员管理机制,建立应急组织机构,优化流程管理体系,以期为综合医院后期建设提供借鉴。     

High-Intensity Interval and Resistance Training Improve Health Outcomes in Older Adults With Coronary Disease

ObjectiveBoth high-intensity interval training (HIIT) and resistance exercises (R) are used in cardiac rehabilitation in patients with coronary artery disease (CAD). However, the combined effect of an HIIT + R exercise program in older adults with CAD is not well investigated. The study's purpose was to assess the changes in anthropometric parameters, physical activity, functional capacity, physiological parameters, and quality of life (QoL) in this population following a combined HIIT + R program.DesignThe study was a 2-group (n = 45 each) randomized controlled single-blinded trial.Setting and ParticipantsThe study was done at a treatment clinic of a tertiary hospital. The mean age of participants was 69.23 ± 4.9 years. The HIIT + R group performed 8 sessions (1/wk) of HIIT + R training. The 30 minutes of the active exercise phase consisted of ten 3-minute bouts. Each bout comprised of 1 minute of high-intensity treadmill walking at 85% to 90% maximum heart rate (MHR), followed by a low-intensity walking at 60%-70% MHR, followed by low-to moderate-intensity resistance training. The Usual Care group underwent conventional medical treatment.MeasuresAnthropometric measurements [weight, body mass index (BMI), waist circumference, body fat percentage, lean body mass], physical activity (International Physical Activity Questionnaire), functional capacity (Incremental Shuttle Walking Test), physiologic measurements (blood pressure, heart rate), and QoL (36-Item Short Form Health Survey) were measured pre- and postintervention.ResultsSignificant group and time interaction were found for the participants in the HIIT + R Group for BMI (P = .001), body fat percentage (P = .001), waist circumference (P < .001), physical activity (P < .001), functional capacity (P < .001), and QoL (P = .001) compared with the UC Group. Significant improvement in systolic blood pressure (P = .001) was seen in the HIIT + R group.Conclusions and ImplicationsA combined HIIT + R training protocol in older adults with CAD can be useful in producing desired health outcomes. Further evaluation of longer duration exercise programs with more frequent dosing needs to be evaluated for their benefits and sustainability.     

基于精细化管理模式下对医学实验室安全管理的探究

医学高等院校实验室是培养医学生创新能力的主要场所,其建设和管理水平是高校科研实力、学科建设实力和人才培养能力的综合体现。将精细化管理模式引用到医学实验室安全管理中,为学生提供一个安全保障的实验环境,才能更有利于实验的顺利开展和高校对人才的培养。本文主要对医学实验室安全管理存在的主要问题进行剖析,并基于精细化管理模式下通过对强化安全教育管理、保障人员配备、引进现代化管理办法等方面创新实验室安全管理进行阐述,为医学高等院校实验室现代化建设提供基本保障。     

运动训练对慢性应激大鼠β—内啡肽分泌的影响

目的：探讨运动训练对慢性应激大鼠β－内啡肽（β－EP）分泌的变化。方法：对大鼠进行为期8周的不同负荷运动训练,并在运动训练后期给予3周的冷刺激,测定大鼠下丘脑和血清中β－EP的含量。结果：（1）经过3周的冷应激后,大鼠产生显著的身心变化,下丘脑和血清β－EP的含量均显著升高,从而表明冷应激可使机体β－ED的合成和释放增多。（2）经过8周的运动训练后,大鼠下丘脑β－EP含量显著升高,血清β－EP含量显著下降;而对运动训练的大鼠施加冷刺激后,大鼠下丘脑和血清中β－EP含量显著低于应激组,以中等负荷运动训练组最为明显。结论：运动训练可以减少内源性β－EP的释放,有效对抗大鼠机体对冷刺激产生的应激反应,维持机体在应激状态下内分泌功能的稳定。     

武警某部女学员有氧耐力训练训练心率的研究

目的为指导和监控部队有氧耐力训练提供参考资料.方法对382名18～22岁女学员依照GJB1337-92和GJB2558-96规定的方法分别测定其安静心率和训练心率.结果安静心率均值为72.85±6.28b/min;按平均年龄21岁计算,中等训练心率为165.76±5.96b/min;最小训练心率为151.17±6.06b/min;最大训练心率为178.23±6.14b/min.结论女学员有氧耐力训练的适宜训练心率为151～178b/min.     

重庆市北碚主城区老年医疗需求现状、对策和模式的研究

目的：了解重庆老人的需求状况以及老人的建议和希望。方法：以重庆市北碚主城区4893名60岁以上的老人进行问卷调查。结果：79．81％的老人患病时就近医疗;86．53％的老人感到看病不方便;86．37％的老人不参加保健咨询;65．48％的老人不听保健讲座;1．02％的老人因心理问题到医院就诊;55．69％的老人愿意参加群众性老年体育活动,随着年龄的增长,希望得到更好的医疗,预防,保健,康复的人数增多。结论：需改善老人看病难的现象,提供多渠道,多形式的老年医疗保健咨询,讲座,组织群众性老年体育活动,使老人的医疗服务需进一步提高和得到重视,争取探索一条以家庭为基础,社区医疗服务为依托,以综合性医院为技术保障,老年医疗康复为中心的模式。